OEdema of the lower extremities is a very common attendant of pregnancy; often occasions no great inconvenience, and is usually confined to the seventh, eighth, and ninth months. It is supposed to arise in most instances from mechanical pressure alone; and to be entirely independent of constitutional disease. This may be true in those cases where it is not accompanied by other dropsical affections. Standing and walking serve to aggravate this condition; it become worse towards evening; gradually increases as pregnancy advances, and is often combined with a varicose state of the veins.
In some instances the oedema becomes very great; the integuments of the lower limbs become enormously distended; and a certain angry redness appears, as if erysipelas would set in. In such cases there is reason to suspect the presence of some more deeply-seated cause than mechanical pressure upon the veins, or even upon the lumbo-sacral nerves; nor will the dropsical infiltration be restricted to the inferior extremities.
OEdema of the vulva will nearly always be present when that of the lower limbs is so largely developed; and this will often cause much suffering in the latter months of gestation; and even render the patient unable to lie on either side. Cases are on enormous that the patients were obliged to lie on their backs with their lower limbs widely separated. In the worst forms of this affection, the tumefaction may occasion considerable relief of the pain arising from the excessive distention of the delicate and sensitive tissue.
Anasarca represents the extension of the oedema, from its original local seat in the lower extremities, over the entire surface of the body. Both oedema or partial dropsy of the cellular or areolar tissue, and anasarca or general dropsy of the same tissue, belong to the class of infiltration, – as contradistinguished from ascites and hydrothorax, which are effusions respectively into the abdominal and thoracic cavities.
The more the oedema comes to resemble anasarca, the more we realize the existence of general, constitutional causes of the affection, and are thus led to look for the means of curing it, in corresponding, constitutional remedies. The attendant symptoms in each case will aid us in the selection of the remedy; since we must prescribe for the patient, not for a particular pathological condition alone, – however distressing it may be, or however thoroughly we may understand it. Much experience proves the truth of this.
Ascites, or dropsical effusion into the cavity of the abdomen, may make its appearance in the first half of pregnancy; although it is more usually developed about the fifth or sixth months, – then continuing during the remainder of the period of gestation.
This affection is attended with more or less oedema of the inferior extremities; of the labia, and infiltration of the abdominal walls. The accumulation of fluid in the abdomen may be slow and gradual; or it may be very rapidly effused, especially after a certain degree of general oedematous infiltration has been reached. In pregnant females, this disorder cannot fail to cause much greater inconvenience and even positive suffering, than in other persons; since it will cause greater obstruction of the movement of the thorax. So great is the dyspnoea in the advanced stages of pregnancy, from this cause, that the respiration becomes as difficult and distressing, and the erect position almost as necessary, as in ordinary cases of hydrothorax. These are frequent attacks of faintness, and a constant sense of suffocation, from the insufficient aeration of the blood. And these sufferings are often aggravated by difficulty of sleeping, headache, thirst and disgust for food.
The presence of water in the abdomen may be determined by percussion; the fluctuation being usually more perceptible in the left hypochondrium just below the false ribs. The existence of any large accumulation of water in the cavity of the abdomen will usually prevent conception, by impeding the action of the fimbriated extremities of the Fallopian tubes; and the same cause tends to prevent the full and healthy development of the foetus, although women with dropsy are said to have had often very lively and healthy children. Ascites should be treated by Homoeopathic physicians with medicines alone if possible; since tapping, either in the earlier or in the later months of pregnancy, is very apt to be followed by the expulsion of the foetus. The severity of the dropsy itself, and the consequent danger of its interfering with gestation, may be measured by the earlier or later period in which it makes its appearance. When the effusion is evident in the first half of the pregnancy, it its increase cannot be arrested, or the disease removed by the use of the appropriate remedies, it may even be necessary to resort to paracentesis.
The causes of ascites, and in fact of all forms of dropsical disorder, – except perhaps the most trifling, which may be considered to result from pressure and general weakness, – must be found in the same constitutional dyscrasia, that have already been referred to in connection with disorders of the blood and its excretions. The morbidly serous condition of the blood forms but a single link in the chain that terminates in cellular infiltration and dropsical effusion. Still farther back we may trace the fault of nutrition, by which the blood is impoverished, rendered watery, and the receptacle or uraemic poisons.
It is important to be familiar with these pathological changes, so far as they can be detected; and some of their objective manifestations may afford valuable aid in selecting the appropriate remedy. Especially, if not only, is this true, where the pathogenesis of the remedy has furnished us with similar pathological symptoms. But that physician will be most successful in his prescriptions, who carefully avoids encumbering his mind with theoretical generalizations; most patiently studies his Materia Medica, and never allows himself to rest satisfied till he has found the remedy which constitutes the most complete simile to all the mental, moral, sensational and physical symptoms of the case.
For the remedies which may be indicated in the various forms of dropsical affections liable to appear in pregnancy, consult those previously mentioned under Dropsy.
And for Dropsy of the Amnion and Hydrorrhoea, see Affections of the Uterus and its Appendages, in the following chapter.
DISORDERS OF PREGNANCY continued
AFFECTIONS OF THE UTERUS; OF ITS APPENDAGES; AND OF THE PELVIC ARTICULATIONS.
THE morbid affections to which the uterus is liable in the pregnant state may be arranged in three classes: First, those which are principally sensational, such as cramps, pains, and excessive sensibility; second, displacements; and third, abnormal secretions, such as leucorrhoea, dropsy of the amnion and hydrorrhoea.
I. PAINS; CRAMPS; SENSIBILITY OF THE UTERUS. – The uterus in pregnancy, even if it does not experience an enlargement of its nerves corresponding to that of the arteries and veins, still partakes in a remarkable manner of the increased sensibility of the nervous system in general. Hence all influences, from within or from without, are very acutely felt, – many of them very painfully, – which, in the unimpregnated condition, would scarcely be noticed. In addition to this excessive sensibility, there are actual uterine pains, seated apparently in the walls of uterus, which are doubtless the result of the contraction of the uterine muscles. These may appear at any time after the first three months of utero-gestation; they may return at intervals, in paroxysms, and increase in severity as the pregnancy advances. These pains may even becomes so severe as to resemble uterine cramps. The excessive sensitiveness of the uterus renders the ordinary motions of the foetus very painful to the mother. And, at the same time, the morbid irritability of the mother’s state in general renders the movements of the foetus much more active and violent. All these morbid conditions may be greatly ameliorated by the exhibition of the appropriate Homoeopathic remedies; thus rendering the patient more comfortable, and at the same time removing influences which might otherwise terminate in abortion.
II. DISPLACEMENTS OF THE UTERUS. – Conception may occur in women who are subject to prolapsus uteri, in cases where the womb is temporarily replaced. Or the already gravid uterus may become subject to either of the different forms of displacement, under the influence of accidental causes connected with its own weight, or with the disproportionate size of the pelvis. In the former case the prolapsus, while it affords no bar to conception, greatly endangers the safety of the foetus until after it is established above the superior strait. In the latter case, the already gravid uterus may be projected so far over the pubes as to constitute anteversion; or turned back in such a manner as to undergo that most formidable displacement called retroversion, by its fundus being lodged beneath the promontory of the sacrum.
